Republican aide says Donald Trump ‘didn’t care or particularly know about healthcare’


Claim comes after President admits ‘we learned a lot about loyalty’ in wake of repeal bill defeat

President Donald Trump “didn’t care or particularly know about health care” despite trying to push a major reform bill through Congress, a senior Republican aide has reportedly claimed.

Mr Trump and top House Republican Paul Ryan tasted defeat on Friday when they were forced to pull the bill, designed to replace Barack Obama’s flagship Affordable Care Act, because they could not get enough votes within their own party to pass it.

The President blamed Democrats for failing to support the plan, but the self-professed dealmaker also said: “We learned a lot about loyalty, we learned a lot about the vote-getting process.” He insisted “Obamacare will explode” eventually and that opposition politicians would see the light and work with him on a new plan.

Vice President Mike Pence and budget director Mick Mulvaney joined Mr Trump in aggressive lobbying for votes with members of the dissenting Republican Freedom Caucus faction, and the President had also tried to court moderates.

However, a Republican congressional aide told CNN: “He didn’t care or particularly know about health care. If you are going to be a great negotiator, you have to know about the subject matter.”

CNN also reported that during a meeting with moderate Republicans, when Pennsylvania congressman Charlie Dent said he did not support the repeal-and-replace bill, Mr Trump said: “Why am I even talking to you?”

In his meeting with the Freedom Caucus the President reportedly urged sceptical legislators to ignore the “little s***” of the policy detail and give him the support he needed.

Among the group’s objections was the “essential health benefits” clause of the bill.

It said that requiring insurance companies to cover a list of items—including, but not limited to, access to mental health services, substance abuse counselling, physical therapy, maternal care and paediatric care like vaccinations—would raise premiums.

The American Health Care Act, Mr Trump and Mr Ryan’s proposed plan, would have left 24 million people uninsured by 2026 according to an analysis by the Congressional Budget Office (CBO).

The CBO also said that while it would have saved the government money, people’s insurance premiums would have risen by between 15 and 20 per cent above the expected increase under Obamacare.

Why UnitedHealth Would Not Be Affected By Obamacare Repeal


The U.S. government took its first steps to repealing the Affordable Care Act on Monday, with House Republicans releasing a detailed proposal in Congress. The proposal repeals much of the ACA and replaces it with a plan to help people buy insurance if they are not provided one by their employer. This is proposed to be done by creating a new tax credit tied to an individual’s age and income. The details of how many people will lose or gain insurance or the impact on the cost of health insurance are unclear at the moment, but at least one major health insurance player is largely safe from this uncertainty – UnitedHealth Group .

UnitedHealth Group, the largest health insurer in the U.S., exited a majority of the health insurance exchanges last year after facing heavy losses. This helped the company’s UnitedHealthCare division post operating income of $7.7 billion in 2016, an increase of 13% year-over-year (y-o-y) while keeping its operating margin stable at around 5.2%.unh-33

Solid performance by the UnitedHealthCare division came in addition to the robust growth reported by Optum – UnitedHealth’s pharmacy benefits management and health care services division. Optum has been the primary growth driver for the company in the last few years, and it continued to drive results in 2016 as well. In 2016, Optum revenues grew about 24% year-over-year (y-o-y) to $83.6 billion, driven by growth across all three sub-segments-

 

 

OptumHealth, OptumInsight, and OptumRx.unh-32

The aforementioned factors highlight how UnitedHealth has gradually made its earnings independent of the ACA, so a potential repeal of the act likely would not have a significant impact on the company. Further, the potential removal of the provision requiring all health plans to provide minimum benefits could help the bottom line for the insurer. This provision, although beneficial for users, increased costs for insurers, and its removal could help improve profitability. Moreover, the draft proposes to make it easier for insurers to easily compete across states, which could help the company grow its user base. While there is still significant uncertainty regarding whether the new healthcare plan will pass, it is unlikely that UnitedHealth will be adversely impacted either way.

House GOP Releases Plan to Repeal, Replace Obamacare


Proposed legislation would dismantle much of Affordable Care Act, create refundable tax credit tied to age and income

  House Republicans took a step toward repealing and replacing Obamacare Monday, releasing their new ‘American Health Care Act’ plan. WSJ’s Shelby Holliday has the details.

House Republicans on Monday released a detailed proposal that marks their first attempt in the new Congress to unite fractious GOP members behind a plan to replace the Affordable Care Act and deliver on a central campaign promise by Republicans.

The proposed legislation would dismantle much of the 2010 law known as Obamacare and create a new tax credit tied to an individual’s age and income, aimed at helping Americans buy insurance if they don’t get it at work.

It is unclear how much the plan will cost or how many people could potentially lose health insurance under the changes as the proposal doesn’t provide an estimate.

 The proposed plan would end the requirement that most Americans have health coverage or pay a penalty, a provision long derided by Republicans, and a mandate that larger employers provide health insurance to workers. It also would repeal most of the health law’s taxes starting in 2018 and freeze funding in 2020 for the 31 states that expanded Medicaid under the law.

The bill is a political gamble for House Republican leaders. The party and President Donald Trump ran for office on promises to repeal and replace the health law. Republicans have said their plan is aimed at decreasing costs and boosting choice for consumers. But to do so, their proposals would likely provide coverage for far fewer people than the ACA, according to a number of research reports.

“Working together, this unified Republican government will deliver relief and peace of mind to the millions of Americans suffering under Obamacare,” said House Speaker Paul Ryan.

 “Trumpcare doesn’t replace the Affordable Care Act, it forces millions of Americans to pay more for less care,” said Senate Minority Leader Chuck Schumer (D., N.Y.)

Earlier versions included provisions opposed by both conservative and centrist Republicans, whose support for the now-altered bill will be crucial.

House Republican leaders hope the package will be passed by Congress by mid-April.

 Mr. Trump praised the bill on Tuesday morning, writing on Twitter, “Our wonderful new Healthcare Bill is now out for review and negotiation. ObamaCare is a complete and total disaster—is imploding fast!”

In a statement Monday night, White House press secretary Sean Spicer called the bill “an important step toward restoring health care choices and affordability back to the American people.”

“President Trump looks forward to working with both Chambers of Congress to repeal and replace Obamacare,” Mr. Spicer said.

The legislation would provide tax credits to people who don’t get coverage through their job, replacing the subsidies the ACA gave to a narrower set of lower-income people to help them afford insurance policies. The ACA subsidies are also tax credits—advance credits paid to insurance companies to lower the cost of health-insurance premiums.

The proposal wouldn’t kill the ACA’s exchanges where people can obtain insurance, but far fewer people are expected to use them because the subsidies that reduce premium costs would no longer exist. Those subsidies are only available now to people who obtain coverage through the state and federal ACA exchanges.

The refundable tax credits have been a thorny issue for Republicans. Conservative Republicans vowed not to support an earlier draft that would have provided the tax credits regardless of income.

Under the House GOP proposal released Monday, the refundable tax credits would be tied to age, with people under 30 eligible for a credit of $2,000 a year, increasing steadily to $4,000 for those over 60. The size of a tax credit would grow with the size of a family, but would be capped at $14,000.

To assuage the concern among conservative lawmakers that the credits would be available to wealthy Americans, the tax credits would start to shrink for individuals making more than $75,000 or households making more than $150,000. For every $1,000 in income over $75,000, the tax credit would be reduced by $100.

In a sign GOP leaders’ changes may have assuaged some conservative concerns, Republican Study Committee Chairman Mark Walker (R., N.C.) said in a statement Monday night that the bill reflects “the right direction.” Mr. Walker, who had opposed an earlier version of the bill, said his group of conservative lawmakers would meet Tuesday evening to review it closely.

In a provision sure to draw resistance from moderate Republicans in the Senate, the House proposal would bar federal funding for the Planned Parenthood Federation of America, which provides reproductive-health services to women.

The bill also maintains the ACA’s Medicaid expansion temporarily. Sixteen Republican governors lead states that chose to expand Medicaid under funding provided by the health law, and they have been pressuring GOP leaders not to repeal the extended federal funding outright.

The GOP plan aims to appease their concerns by leaving the expansion untouched through the end of 2019. After that, funding would begin to be reduced in an attempt to make up for the revenue lost by repealing the taxes contained in the existing health law.

Beginning in January 2020, the federal government would transition into a system in which a set amount of funding would be sent to the states each year. The move is expected to save the federal government significant money over time but could result in fewer people having insurance coverage.

Bruce Siegel, president and chief executive officer of America’s Essential Hospitals, an association of public and nonprofit hospitals, urged Congress to wait for a Congressional Budget Office evaluation, or score, of the bill before taking action. “Without a CBO score, there are too many unknowns and too great a risk of coverage losses without affordable alternatives for many Americans,” he said.

Republican Sens. Rob Portman of Ohio, Lisa Murkowski of Alaska, Cory Gardner of Colorado and Shelley Moore Capito of West Virginia sent a letter Monday to Senate Majority Leader Mitch McConnell (R., Ky.) expressing concerns over the House’s approach to overhauling the Medicaid program in an earlier draft of the bill.

“We believe Medicaid needs to be reformed, but reform should not come at the cost of disruption in access to health care for our country’s most vulnerable and sickest individuals,” the four lawmakers wrote.

Ms. Capito said Monday night that the House’s health-care plan was “moving in the right direction,” but that she needed to look at it more closely before backing it. She said she worried that the tax credit might not be generous enough for low-income individuals. “My understanding is that it’s on the low side.” she said.

House Republicans ducked one fight by deciding not to change the popular tax break on health plans that people get through their employer.

Instead, they are planning to pay for the bill by allowing the ACA’s taxes to remain in place until the start of 2018. They also would allow the tax on expensive employer health plans to kick in on Jan. 1, 2025, instead of being repealed. Congress already had voted to delay the tax until 2020.

That could prove unpopular with conservative Republicans, who wanted to get rid of all of the 2010 health law’s taxes immediately.

The House GOP bill also would expand health savings accounts aimed at helping people save money for health costs.

The proposal would also end a special executive compensation limit that the 2010 law applied to health insurers. That law prevented companies from deducting more than $500,000 in pay to executives. Other companies face a $1 million limit, but that cap doesn’t apply to performance-based compensation.

The bill, which was largely completed over the weekend in closed-door meetings with the White House and GOP leadership, is expected to be voted on in House committees this week.

To pass the bill, Republicans can’t lose more than two GOP votes in the Senate and 22 in the House, assuming no support from Democrats.

House Republicans took a step toward repealing and replacing Obamacare Monday, releasing their new ‘American Health Care Act’ plan. WSJ’s Shelby Holliday has the details.

House Republicans on Monday released a detailed proposal that marks their first attempt in the new Congress to unite fractious GOP members behind a plan to replace the Affordable Care Act and deliver on a central campaign promise by Republicans.

The proposed legislation would dismantle much of the 2010 law known as Obamacare and create a new tax credit tied to an individual’s age and income, aimed at helping Americans buy insurance if they don’t get it at work.

It is unclear how much the plan will cost or how many people could potentially lose health insurance under the changes as the proposal doesn’t provide an estimate.

 The proposed plan would end the requirement that most Americans have health coverage or pay a penalty, a provision long derided by Republicans, and a mandate that larger employers provide health insurance to workers. It also would repeal most of the health law’s taxes starting in 2018 and freeze funding in 2020 for the 31 states that expanded Medicaid under the law.

The bill is a political gamble for House Republican leaders. The party and President Donald Trump ran for office on promises to repeal and replace the health law. Republicans have said their plan is aimed at decreasing costs and boosting choice for consumers. But to do so, their proposals would likely provide coverage for far fewer people than the ACA, according to a number of research reports.

“Working together, this unified Republican government will deliver relief and peace of mind to the millions of Americans suffering under Obamacare,” said House Speaker Paul Ryan.

 “Trumpcare doesn’t replace the Affordable Care Act, it forces millions of Americans to pay more for less care,” said Senate Minority Leader Chuck Schumer (D., N.Y.)

Earlier versions included provisions opposed by both conservative and centrist Republicans, whose support for the now-altered bill will be crucial.

House Republican leaders hope the package will be passed by Congress by mid-April.

 Mr. Trump praised the bill on Tuesday morning, writing on Twitter, “Our wonderful new Healthcare Bill is now out for review and negotiation. ObamaCare is a complete and total disaster—is imploding fast!”

In a statement Monday night, White House press secretary Sean Spicer called the bill “an important step toward restoring health care choices and affordability back to the American people.”

“President Trump looks forward to working with both Chambers of Congress to repeal and replace Obamacare,” Mr. Spicer said.

The legislation would provide tax credits to people who don’t get coverage through their job, replacing the subsidies the ACA gave to a narrower set of lower-income people to help them afford insurance policies. The ACA subsidies are also tax credits—advance credits paid to insurance companies to lower the cost of health-insurance premiums.

The proposal wouldn’t kill the ACA’s exchanges where people can obtain insurance, but far fewer people are expected to use them because the subsidies that reduce premium costs would no longer exist. Those subsidies are only available now to people who obtain coverage through the state and federal ACA exchanges.

The refundable tax credits have been a thorny issue for Republicans. Conservative Republicans vowed not to support an earlier draft that would have provided the tax credits regardless of income.

Under the House GOP proposal released Monday, the refundable tax credits would be tied to age, with people under 30 eligible for a credit of $2,000 a year, increasing steadily to $4,000 for those over 60. The size of a tax credit would grow with the size of a family, but would be capped at $14,000.

To assuage the concern among conservative lawmakers that the credits would be available to wealthy Americans, the tax credits would start to shrink for individuals making more than $75,000 or households making more than $150,000. For every $1,000 in income over $75,000, the tax credit would be reduced by $100.

In a sign GOP leaders’ changes may have assuaged some conservative concerns, Republican Study Committee Chairman Mark Walker (R., N.C.) said in a statement Monday night that the bill reflects “the right direction.” Mr. Walker, who had opposed an earlier version of the bill, said his group of conservative lawmakers would meet Tuesday evening to review it closely.

In a provision sure to draw resistance from moderate Republicans in the Senate, the House proposal would bar federal funding for the Planned Parenthood Federation of America, which provides reproductive-health services to women.

The bill also maintains the ACA’s Medicaid expansion temporarily. Sixteen Republican governors lead states that chose to expand Medicaid under funding provided by the health law, and they have been pressuring GOP leaders not to repeal the extended federal funding outright.

The GOP plan aims to appease their concerns by leaving the expansion untouched through the end of 2019. After that, funding would begin to be reduced in an attempt to make up for the revenue lost by repealing the taxes contained in the existing health law.

Beginning in January 2020, the federal government would transition into a system in which a set amount of funding would be sent to the states each year. The move is expected to save the federal government significant money over time but could result in fewer people having insurance coverage.

Bruce Siegel, president and chief executive officer of America’s Essential Hospitals, an association of public and nonprofit hospitals, urged Congress to wait for a Congressional Budget Office evaluation, or score, of the bill before taking action. “Without a CBO score, there are too many unknowns and too great a risk of coverage losses without affordable alternatives for many Americans,” he said.

Republican Sens. Rob Portman of Ohio, Lisa Murkowski of Alaska, Cory Gardner of Colorado and Shelley Moore Capito of West Virginia sent a letter Monday to Senate Majority Leader Mitch McConnell (R., Ky.) expressing concerns over the House’s approach to overhauling the Medicaid program in an earlier draft of the bill.

“We believe Medicaid needs to be reformed, but reform should not come at the cost of disruption in access to health care for our country’s most vulnerable and sickest individuals,” the four lawmakers wrote.

Ms. Capito said Monday night that the House’s health-care plan was “moving in the right direction,” but that she needed to look at it more closely before backing it. She said she worried that the tax credit might not be generous enough for low-income individuals. “My understanding is that it’s on the low side.” she said.

House Republicans ducked one fight by deciding not to change the popular tax break on health plans that people get through their employer.

Instead, they are planning to pay for the bill by allowing the ACA’s taxes to remain in place until the start of 2018. They also would allow the tax on expensive employer health plans to kick in on Jan. 1, 2025, instead of being repealed. Congress already had voted to delay the tax until 2020.

That could prove unpopular with conservative Republicans, who wanted to get rid of all of the 2010 health law’s taxes immediately.

The House GOP bill also would expand health savings accounts aimed at helping people save money for health costs.

The proposal would also end a special executive compensation limit that the 2010 law applied to health insurers. That law prevented companies from deducting more than $500,000 in pay to executives. Other companies face a $1 million limit, but that cap doesn’t apply to performance-based compensation.

The bill, which was largely completed over the weekend in closed-door meetings with the White House and GOP leadership, is expected to be voted on in House committees this week.

To pass the bill, Republicans can’t lose more than two GOP votes in the Senate and 22 in the House, assuming no support from Democrats.

Trump Says Private Firms Can Fix Obamacare But They Underpin the ACA


President-elect Trump just promised that private insurance companies can help lower costs and get health insurance to more Americans.

But private health insurance already forms the basis of the Obamacare exchanges that Republicans have vowed to raze. And a conversation with just about any American covered by private health insurance makes it’s immediately clear that the private health insurance industry is a source of many, if not most, of the frustrations of managing health insurance.

“We’re going to get private insurance companies to take care of a lot of the people that can afford it. That’s going to take a tremendous burden off and they’re going to be able to have plans that are great plans,” Trump said in an interview aired Wednesday on the Fox news channel.

That’s pretty close to the goals of the 2010 Patient Protection and Affordable Care Act, widely known as Obamacare or the ACA.

“The ACA is a fairly free-market oriented health care proposal, more than I think many people on the left would have liked,” said Sherry Glied, dean of New York University’s Robert F. Wagner Graduate School of Public Service. “For the most part, companies can decide more or less what they want to do.”

Obamacare set up health insurance exchanges where people who couldn’t get good coverage any other way could go to buy policies regulated by the new rules, often with a generous federal subsidy.

It sought to stop the worst insurance company abuses, such as cutting off coverage when people got too sick, and sought to get rid of some of the most bare-bones plans that had low premiums but that also often left people in the lurch when they actually needed coverage.

Yet people still have struggled with denied claims, red tape and surprise medical bills, even on the Obamacare policies.

Abigail Leigh has been fighting with her provider, Anthem Blue Cross and Blue Shield in Virginia, to pay for an emergency visit she made last August to an urgent care clinic while visiting her home state of South Carolina.

“It became very painful to breathe,” Leigh, a pharmacy student in Richlands, Virginia, told NBC News.

“I had to take very short breaths to even breathe at all. I was starting to get a little dizzy. So we decided to go to urgent care.”

The symptoms pointed to a potentially deadly blood clot in the lung, called a pulmonary embolism, so doctors ordered a battery of tests.

Luckily for her it wasn’t. “He decided I must have pleuritis, which is an inflammation of the lining of my lungs,” said Leigh. The total bill: more than $1,700.

“I later on got a statement from my insurance company saying they won’t cover it.”

Leigh’s been going back and forth with the insurance company. Her $184-a-month policy, which she bought through the exchange that the federal government runs on Virginia’s behalf, doesn’t cover out-of-state care, unless it’s emergency care. Leigh argues that her case is clearly emergency care, but as of this week her appeal is still unanswered.

“Now I’m having to call the hospital facility and keep them from sending the bill to collection,” Leigh said. “I don’t feel like I should be having to keep up on this.”

It’s a problem that easily could have existed pre-ACA, but Leigh said these kinds of negotiations should have been addressed by the law.

The American College of Emergency Physicians (ACEP) lays the blame at the feet of the health insurance companies.

“No one chooses when they will need emergency care and should not be punished financially for having emergencies or discouraged from seeking medical attention when they are sick or injured,” said ACEP president Dr. Rebecca Parker.

“There have been significant reductions in insurance payments for emergency care, as much as 70 percent. They have taken gross advantage of patients and emergency medical providers since the ACA, arbitrarily slashing payments to physicians,” Parker added.

In some states, such as California, the exchanges have attracted many insurance companies and offer a variety of policies. In others, problems caused some insurance companies to abandon the exchanges, saying they can’t make enough money.

That’s what happened to Beverly Deeds, who lost her Blue Cross Blue Shield plan in Santa Fe, New Mexico when the insurer dropped off her state’s exchange. “They left me high and dry,” said Deeds, a 62-year-old retiree.

The only insurer left for Deeds was Christus. Deeds had been paying $250 a month, with a $6,000 deductible, she said.

After making several phone calls, Deeds got a bronze-level Christus plan for $449 a month. The bare-bones bronze plans are meant to provide catastrophic coverage for people who are generally healthy.

“The deductible is just under $7,000,” she said. Her husband, who has Medicare coverage, earns too much for her to qualify for a federal subsidy or for Medicaid, even though New Mexico did opt in to the federal expansion of the program.

“I hate it,” said Deeds, who says she voted against Obama but she says there’s plenty of blame to go around for what she sees as the ACA’s failures. “The insurance companies slanted things so they made a lot of money. Obamacare really padded their pockets,” she said.

Now, even though she qualifies for free annual mammograms and well-woman checkups, Deeds doesn’t go. “I’m scared to death. If I got diagnosed with something, how would I pay with that $7,000 deductible?” she asked.

“I think there’s a lot of frustration out there where this law was passed and was supposed to fix problems with the health care system, and people feel they are still paying a lot and don’t understand why the law hasn’t done more to help them,” said Liz Hamel, who leads polling for the nonpartisan Kaiser Family Foundation.

A report out this week from consultancy firm Avalere Health shows that the 11.5 million people getting health insurance on the exchanges in 2017 will pay more and often get less for their money than in previous years, although federal subsidies will close the gap for 81 percent of customers.

“Following several years of single-digit premium growth, premiums increased 12 percent on average for silver plans in 2017—from $496 per month in 2016 to $554 per month in 2017,” Avalere says.

Fewer than a third of policies are the preferred provider organizations (PPO) or point of service (POS) plans that offer customers a wide choice of doctors, hospitals and other providers. Deductibles for the silver plans – the plans that qualify for federal subsidies – grew by 20 percent for 2017.

America’s Health Insurance Plans, which represents insurance companies, says prices depend on competition in each state, and says some of the ACA’s rules have driven up costs. “Health insurance premiums are set based on a complex set of factors that reflect the cost of providing coverage in a state and in a market,” it says.

Trump Says Private Firms Can Fix Obamacare But They Underpin the ACA by MAGGIE FOX


President-elect Trump just promised that private insurance companies can help lower costs and get health insurance to more Americans.

But private health insurance already forms the basis of the Obamacare exchanges that Republicans have vowed to raze. And a conversation with just about any American covered by private health insurance makes it’s immediately clear that the private health insurance industry is a source of many, if not most, of the frustrations of managing health insurance.

Private health insurance already forms the basis of the Obamacare exchanges that Republicans have vowed to raze
President-elect Trump just promised that private insurance companies can help lower costs and get health insurance to more Americans. But private health insurance already forms the basis of the Obamacare exchanges that Republicans have vowed to raze 

“We’re going to get private insurance companies to take care of a lot of the people that can afford it. That’s going to take a tremendous burden off and they’re going to be able to have plans that are great plans,” Trump said in an interview aired Wednesday on the Fox news channel.

That’s pretty close to the goals of the 2010 Patient Protection and Affordable Care Act, widely known as Obamacare or the ACA.

“The ACA is a fairly free-market oriented health care proposal, more than I think many people on the left would have liked,” said Sherry Glied, dean of New York University’s Robert F. Wagner Graduate School of Public Service. “For the most part, companies can decide more or less what they want to do.”

Obamacare set up health insurance exchanges where people who couldn’t get good coverage any other way could go to buy policies regulated by the new rules, often with a generous federal subsidy.

It sought to stop the worst insurance company abuses, such as cutting off coverage when people got too sick, and sought to get rid of some of the most bare-bones plans that had low premiums but that also often left people in the lurch when they actually needed coverage.

Yet people still have struggled with denied claims, red tape and surprise medical bills, even on the Obamacare policies.

Abigail Leigh has been fighting with her provider, Anthem Blue Cross and Blue Shield in Virginia, to pay for an emergency visit she made last August to an urgent care clinic while visiting her home state of South Carolina.

“It became very painful to breathe,” Leigh, a pharmacy student in Richlands, Virginia, told NBC News.

“I had to take very short breaths to even breathe at all. I was starting to get a little dizzy. So we decided to go to urgent care.”

The symptoms pointed to a potentially deadly blood clot in the lung, called a pulmonary embolism, so doctors ordered a battery of tests.

Luckily for her it wasn’t. “He decided I must have pleuritis, which is an inflammation of the lining of my lungs,” said Leigh. The total bill: more than $1,700.

“I later on got a statement from my insurance company saying they won’t cover it.”

Leigh’s been going back and forth with the insurance company. Her $184-a-month policy, which she bought through the exchange that the federal government runs on Virginia’s behalf, doesn’t cover out-of-state care, unless it’s emergency care. Leigh argues that her case is clearly emergency care, but as of this week her appeal is still unanswered.

“Now I’m having to call the hospital facility and keep them from sending the bill to collection,” Leigh said. “I don’t feel like I should be having to keep up on this.”

It’s a problem that easily could have existed pre-ACA, but Leigh said these kinds of negotiations should have been addressed by the law.

The American College of Emergency Physicians (ACEP) lays the blame at the feet of the health insurance companies.

“No one chooses when they will need emergency care and should not be punished financially for having emergencies or discouraged from seeking medical attention when they are sick or injured,” said ACEP president Dr. Rebecca Parker.

“There have been significant reductions in insurance payments for emergency care, as much as 70 percent. They have taken gross advantage of patients and emergency medical providers since the ACA, arbitrarily slashing payments to physicians,” Parker added.

In some states, such as California, the exchanges have attracted many insurance companies and offer a variety of policies. In others, problems caused some insurance companies to abandon the exchanges, saying they can’t make enough money.

That’s what happened to Beverly Deeds, who lost her Blue Cross Blue Shield plan in Santa Fe, New Mexico when the insurer dropped off her state’s exchange. “They left me high and dry,” said Deeds, a 62-year-old retiree.

The only insurer left for Deeds was Christus. Deeds had been paying $250 a month, with a $6,000 deductible, she said.

After making several phone calls, Deeds got a bronze-level Christus plan for $449 a month. The bare-bones bronze plans are meant to provide catastrophic coverage for people who are generally healthy.

“The deductible is just under $7,000,” she said. Her husband, who has Medicare coverage, earns too much for her to qualify for a federal subsidy or for Medicaid, even though New Mexico did opt in to the federal expansion of the program.

“I hate it,” said Deeds, who says she voted against Obama but she says there’s plenty of blame to go around for what she sees as the ACA’s failures. “The insurance companies slanted things so they made a lot of money. Obamacare really padded their pockets,” she said.

Now, even though she qualifies for free annual mammograms and well-woman checkups, Deeds doesn’t go. “I’m scared to death. If I got diagnosed with something, how would I pay with that $7,000 deductible?” she asked.

“I think there’s a lot of frustration out there where this law was passed and was supposed to fix problems with the health care system, and people feel they are still paying a lot and don’t understand why the law hasn’t done more to help them,” said Liz Hamel, who leads polling for the nonpartisan Kaiser Family Foundation.

A report out this week from consultancy firm Avalere Health shows that the 11.5 million people getting health insurance on the exchanges in 2017 will pay more and often get less for their money than in previous years, although federal subsidies will close the gap for 81 percent of customers.

“Following several years of single-digit premium growth, premiums increased 12 percent on average for silver plans in 2017—from $496 per month in 2016 to $554 per month in 2017,” Avalere says.

Fewer than a third of policies are the preferred provider organizations (PPO) or point of service (POS) plans that offer customers a wide choice of doctors, hospitals and other providers. Deductibles for the silver plans – the plans that qualify for federal subsidies – grew by 20 percent for 2017.

America’s Health Insurance Plans, which represents insurance companies, says prices depend on competition in each state, and says some of the ACA’s rules have driven up costs. “Health insurance premiums are set based on a complex set of factors that reflect the cost of providing coverage in a state and in a market,” it says.

Health and medicine 2014: Ebola, MERS, surgeon general, hepatitis C, Obamacare.


What else happened besides the Ebola outbreak?

Ebola and E-Cigarrettes.
Ebola and e-cigarettes, two of the most important medical stories of 2014.

Photo illustration by Juliana Jiménez Jaramillo.

It was a weird, fascinating year for medicine. Did you know there was a mumps outbreak in the National Hockey League? Or that a man turned his amputated leg into a lamp and tried to auction it off on eBay? (Starting bid: $80,000.) I polled medical experts in a wide range of specialties to compile the 10 most important medical stories of the year.

No. 10: The NRA flexes its muscle.

Can you name our surgeon general? And where was this person during the Ebola panic? Or the Obamacare rollout? It turns out we spent much of 2014 without one—the position became vacant in July 2013—and it’s because of an errant tweet. During the vetting process, it was revealed that Obama’s nominee, a physician/entrepreneur named Vivek Murthy, had tweeted this on Oct. 16, 2012:

This led the National Rifle Association to lobby red-state Democrats to join most Republicans and vote against Murthy’s confirmation. Murthy testified that he would not pursue gun control legislation—he has no power to do so, and his primary interest is the obesity epidemic—but there were enough election-year jitters to scuttle his nomination. After the midterms, some Democrats, including Sens. Mark Pryor of Arkansas and Jon Tester of Montana, said they were willing to reconsider. Murthy was finally confirmed as the nation’s 19th surgeon general on Dec. 15.

No. 9: Human enterovirus 68 and xenophobia.

On Aug. 19, the Centers for Disease Control and Prevention was notified by a hospital in Missouri that it was noticing an increase in children hospitalized with severe respiratory illness—including many admitted to the intensive care unit. It turned out they were suffering from a somewhat obscure respiratory infection called enterovirus 68. From mid-August to Dec. 4, a reported 1,121 people in 47 states and the District of Columbia came down with it. There were three unusual things about this year’s enterovirus 68 outbreak: It was much larger than the sporadic cluster of cases that have been popping up since 2005. It appeared to be causing a poliolike syndrome that left children paralyzed. And conservative pundits erroneously tried to blame the outbreak on undocumented immigrants.

No. 8: Corporations get religion.

Hobby Lobby, the Oklahoma-based arts-and-crafts chain, challenged a new regulation requiring health insurance provided by employers to cover emergency contraceptives. The company was founded by a man named David Green, who argued that his family’s religious beliefs forbade them “from participating in, providing access to, paying for, training others to engage in, or otherwise supporting abortion-causing drugs and devices.”

Oral arguments at the Supreme Court in Sebelius v. Hobby Lobby were heard on March 25. Three months later, on June 30, the court, citing the Religious Freedom Restoration Act, ruled 5–4 that Hobby Lobby and other “closely held” corporations could exempt themselves from the law based on religious preferences.

No. 7: The rise of e-cigarettes.

The list of celebrity endorsements, paid or otherwise, is enough to make anyone skeptical: Jose Canseco, Kevin Federline, Danny Bonaduce, and Stephen Dorff. Charlie Sheen declared that he, too, wants to be involved, announcing an electronic cigarette line called “Nicosheen” in partnership with everyone’s favoriteex-con, Lenny Dykstra. They all rave about e-cigarettes, touting them as a cheap and healthy way to quit smoking. But a new study shows that e-cigarette vapors contain carcinogenic preservatives like acetaldehyde and formaldehyde, in addition to the highly addictive main ingredient, nicotine. Scores of cities chose to rewrite their laws in 2014, restricting e-cigarette use in smoke-free venues (the town of Westminster, Massachusetts, proposed banning them entirely), and experts from the world’s leading lung organizations—including the American Thoracic Society, American College of Chest Physicians, and the European Respiratory Society—released a position statement on e-cigarettes calling for them to be “banned until more about their safety is available.” Perhaps inspired by this controversy, e-cigarettes became the go-to movie prop in 2014 for villains who need to look “too slick to be trusted.”

No. 6: MERS alert.

A lethal virus called Middle East Respiratory Syndrome Coronavirus, or MERS-CoV, was first recognized in 2012 in a man in Saudi Arabia who developed kidney failure and pneumonia. On May 2, the first imported case was confirmed in the United States. Nine days later, a second case of MERS appeared in the U.S. Both cases were diagnosed in travelers from Saudi Arabia. Although the cases were unrelated, it freaked out a lot of people. There is no vaccine, no cure, and as many of 60 percent of infected patients die. By June, the virus had been confirmed in 22 countries, including the United Kingdom, Egypt, Turkey, and Austria. Scientists figured out that the virus lives in camels (and possibly bats), and aggressive infection control measures quelled the outbreak—just as another viral pandemic in Western Africa started making news.

No. 5: Flu vaccine underwhelms.

This season’s flu vaccine has been underperforming. It is less than 50 percent effective against the predominant circulating strain of influenza, called H3N2. Many commenters asked why vaccine-makers don’t include more strains—the current shot contains three or four influenza strains, depending on the brand. We could put more strains in, but that would drive the cost of the vaccine way up while providing little extra coverage. The vaccine-makers actually predicted the correct strains this year, but the predominant subtype has mutated ever so slightly, in a process called antigenic drift.

No. 4: Hacktivists hit Harvard.

This summer, Boston Children’s Hospital was targeted in a cyberattack reportedly instigated by the group Anonymous. It had to do with a highly publicized case in which a teenager named Justina Pelletier was taken into custody by child protective services because doctors were afraid she was being abused at home. Anonymous threatened the Harvard-affiliated hospital with retaliation if it didn’t take disciplinary action against certain doctors, and the group demanded the immediate return of the child to her parents. The attack started off rather mildly: Hackers posted the personal information of doctors involved in the case. Then, weeks later, the hospital was subjected to attacks affecting its Internet connectivity. The group also employed “spear phishing” emails, attempting to get health care workers to open attachments that provided a way for attackers to get behind the hospital’s firewall. The attacks ultimately subsided after members of Anonymous tweeted calls to back off.

No. 3: New drugs in the pipeline.

This was a great year for new treatment of three chronic, debilitating diseases: hepatitis C, congestive heart failure, and idiopathic pulmonary fibrosis.

Idiopathic pulmonary fibrosis is a chronic and ultimately fatal lung disease characterized by a progressive decline in the ability to breathe. An estimated 30,000 to 50,000 people are diagnosed with IPF each year, and the five-year survival rate is dismal. There is no good treatment; many physicians compare it with being diagnosed with terminal cancer. In May, however, a randomized, double-blind, placebo-controlled trial showed that a new drug called pirfenidone dramatically reduced disease progression, halving the rate of decline at one year of treatment. It wasn’t a cure, but it was a bright spot for patients with this devastating illness.

There are roughly 200 million people in the world with hepatitis C. Until this year they had very few treatment options, and the ones that existed—which included a gnarly drug called interferon—weren’t very effective and had lots of terrible side effects. And most of these drugs had to be administered intravenously. This year, the Food and Drug Administration approved a new oral treatment called sofosbuvir, which, in combination with another drug called ledipasvir, providesremarkably high cure rates for people infected with hepatitis C, genotype 1—the most common subtype in the United States, Japan, and much of Europe. The downside? Sofosbuvir is priced between $80,000 and $160,000 for 12 weeks of therapy. Thankfully, there are more oral treatments for hepatitis C in the pipeline, which should drive the costs down.

Heart failure occurs when the heart is unable to sufficiently pump blood to meet the needs of the body. For 25 years, the cornerstone of treatment has included an angiotensin converting enzyme inhibitor. This year, a new type of drug called a neprilysin inhibitor, which prevents an enzyme called neprilysin from degrading proteins that dilate blood vessels, was shown in a landmark trial to dramatically reduce the risks of hospitalization and death for patients with heart failure when given with another drug called an angiotensin receptor blocker.

No. 2: The Obamacare rollout.

It’s unclear what the Affordable Care Act will look like (or if it will exist) in a few years, so for posterity, let’s look at how it all started. Open enrollment began on Oct. 1, 2013, offering Medicaid eligibility to citizens with incomes at or below 138 percent of the federal poverty level in participating states. It also provided tax credits for private insurance purchased via marketplaces for people who weren’t eligible for Medicaid but had incomes between 100 percent and 400 percent of the federal poverty level. The rollout was a bit of a mess, and on April 10, Kathleen Sebelius announced her resignation as secretary of Health and Human Services.

Tens of thousands of previously uninsured Americans enrolled in health insurance exchanges, and as the year drew to a close, the Obama administration claimed victory. But on Nov. 7, the Supreme Court made the surprise announcement that it would hear King v. Burwell, the latest challenge to the Affordable Care Act. The casehinges on the legality of the Internal Revenue Service extending tax credits to the 4.5 million people who bought their health plans in the 34 states that declined to establish their own health insurance exchanges. Expect a ruling in June.

No. 1: Coming to America: The Ebola Outbreak.

This story drowned out just about everything else having to do with medicine in 2014. Although it’s fading from the headlines now, the worst Ebola epidemic in history isn’t over. But rather than looking back, let’s look ahead at what’s to come.

As novel vaccines and treatments become available in the coming months, a practical and ethical issue will emerge: How should we use them? In particular, should we perform a clinical trial using a control group when the next promising, untested drug becomes available? Or should we just give the new drug to everyone? A well-designed, randomized trial would benefit medicine in the long term, but it might be at the expense of the people who have Ebola today. (If the new drug works and you have Ebola, you don’t want to be randomly assigned to the group that doesn’t get the drug; if the new drug turns out to be more dangerous than a lack of treatment, it could lead to even more deaths.) For the record, I think we should perform a randomized control trial when the next Ebola drug becomes available: It’s the only way we’ll really know if the new treatment actually works.

These were the 10 stories that rocked my world in 2014. Just missing the cut were a change in the approach to cancer screening and an unsuccessful trial aimed at treating high blood pressure. What stories were important to you?